Organization
LIFE REDISCOVERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELICIA WATTS (CEO)
(678) 545-6768
Entity
Organization
Contact information
Practice address
113 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2540
(678) 545-6768
(678) 528-9489
Mailing address
113 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2540
(678) 545-6768
(678) 528-9489
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003212493A
—
GA
Enumeration date
02/03/2016
Last updated
04/19/2022
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